REVIEW   

Italian Journal of Vascular and Endovascular Surgery 2017 September;24(3):107-17

DOI: 10.23736/S1824-4777.17.01301-8

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Contemporary repair of type A aortic dissection

Philip L. AUYANG ✉, Jean BISMUTH, Michael J. REARDON

Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA

INTRODUCTION: Type A dissection is a surgical emergency with an extremely high mortality rate without intervention. Despite over four decades of surgical treatment mortality and morbidity remain high. Traditionally, type A dissections have been approached through an open surgical operation, and the extent ranges from a basic ascending aortic replacement, to valvular suspension, aortic root replacement, supra-aortic trunk debranching, or total arch replacement. With the improvement in endovascular devices, the rates of stent graft repair have increased dramatically, albeit with off label devices.
EVIDENCE ACQUISITION: A PubMed search of literature published in English language between 1965 and 2017 to survey past and present-day type A aortic dissection management. In addition we review our institutions experience with type A dissection management.
EVIDENCE SYNTHESIS: This review is a focus on the evolution of surgical therapy and early outcomes for endovascular treatment. Disadvantages and advantages to both approaches are reviewed here.
CONCLUSIONS: Improvements in surgical technique and peri-operative management has led to a decrease in mortality and morbidity although results remain sub-optimal. New approaches and techniques including endovascular stent graft repair are under development with promising early results.

KEY WORDS: Dissection - Aorta, thoracic - Therapy - Surgery